An epidemiologic study of the carpal tunnel syndrome in an adult female population

doi:10.1016/0091-7435(85)90021-0

Preventive Medicine

Volume 14, Issue 1, January 1985, Pages 63-69

https://doi.org/10.1016/0091-7435(85)90021-0 Get rights and content

Abstract

The relationships between certain reproductive, demographic, and medical variables and the carpal tunnel syndrome were examined using data from a hospital-based case-control study of women ages 45 to 74 years in the New Haven and Hartford, Connecticut, areas from 1977 to 1979. Characteristics of 40 carpal tunnel syndrome cases and 1,043 controls from hospital surgical services were compared. A history of diabetes was associated with an increased frequency of occurrence of the carpal tunnel syndrome, a finding consistent with clinical observation. Recent weight gain and use of estrogen replacement therapy were identified as possible risk factors; this provides some support for the theory that fluid retention in the soft tissues of the carpal tunnel is etiologically involved, although these results are preliminary and further research must be carried out to refute or support these findings. The negative association of the carpal tunnel syndrome with height and a history of varicose veins and the positive association with age at menopause cannot be explained and need verification.

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Cited by (65)

Carpal tunnel syndrome
2013, Orthopaedics and Trauma
Citation Excerpt :
They concluded that hormonal factors related to sex play a major role in the ætiology of this disease affecting mainly women (71%).86 The age at menopause is also a significant factor.50,81 Oophorectomy: in another controlled study comparing oophorectomized women with a control group Pascual et al. found that in the oophorectomized group, 17 of 53 (32%) had clinical CTS, while only seven of 70 of the control group (10%) did so (relative risk for the oophorectomized group = 4.25; 95% confidence intervals 1.47 and 12.61).
When the intracarpal canal interstitial pressure rises above a critical threshold pressure, capillary blood flow is reduced below the level required for median nerve function, then viability. The associated symptoms include pain, paræsthesiæ and altered sensation, or a combination of these. While primary carpal tunnel syndrome can result from direct trauma to the contents of the carpal tunnel or surrounding tissues, the more common type is idiopathic and multi-factorial, with a multitude of risk factors. There is considerable confusion in the literature between risk factors and factors that provoke the symptoms. This paper analyses the published evidence for the rôle that each of the risk factors plays in the ætiology of carpal tunnel syndrome.
Disparity Between Popular (Internet) and Scientific Illness Concepts of Carpal Tunnel Syndrome Causation
2008, Journal of Hand Surgery
Citation Excerpt :
The NIOSH Report was published by the Public Health Service branch of the U.S. Department of Health and Human Services in July 1997 as a “Critical Review of Epidemiologic Evidence for Work Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back” (http://www.cdc.gov/niosh/egoscil.html). Twenty-eight references from this report addressed the etiology of idiopathic CTS.13,24,32,34–58 The following factors were mentioned as being causally related to CTS in at least one article: genetic predisposition, tenosynovitis, repetitive wrist or finger motion, typing or computer use, and etiology unknown (idiopathic).
To determine whether there are notable disparities between popular (Internet) and scientific (Index Medicus) theories of carpal tunnel syndrome (CTS) causation.
Reports from 3 sources were evaluated with regard to support for etiological theories of CTS: 1) patient-oriented information on CTS from the Internet, 2) recent physician-oriented information on CTS from medical journals indexed on Index Medicus, and 3) articles addressing the etiology of CTS from the 1997 National Institute for Occupational Safety and Health report. Multiple logistic regression analyses evaluated differences in etiological theories from the 3 sources.
Internet sites implicated vitamin B₆ deficiency, tenosynovitis, and typing or computer use as causes for idiopathic CTS considerably more often and genetic predisposition considerably less often than recent Index Medicus scientific reports and reports reviewed by the National Institute for Occupational Safety and Health.
There are notable disparities between popular (Internet) and scientific (Index Medicus) theories of CTS causation.
Carpal tunnel syndrome in postmenopausal women
2008, Journal of the Neurological Sciences
Hormonal changes that accompany menopause have a significant impact on the nervous and other physiological systems. Our objective was to evaluate the relationship between carpal tunnel syndrome (CTS) and the clinical features of menopause in postmenopausal women, in comparison to age-matched healthy controls.
Overall, 6230 women were seen during the study period. Of these, 5587 were not eligible because they were premenopausal or perimenopausal. 537 women did not meet the criteria used in the study for a diagnosis of idiopathic CTS and were excluded.
Finally, one hundred and six patients with CTS and 115 controls were examined. The presence of CTS was confirmed both clinically and electrophysiologically. Socio-demographic variables and reproductive histories were evaluated via a structured interview.
In comparison to healthy controls, patients with CTS showed a significantly greater number of pregnancies and an earlier age at menopause. Regarding the type of menopause, patients and controls showed similar frequencies for natural versus surgical menopause. The frequency of natural menopause was significantly higher than that of surgical menopause in both groups.
Our results suggest that age at menopause may be a significant factor in the development of CTS. Pregnancy-related hormonal changes may have long-term effects that increase the incidence of CTS in postmenopausal women.
The Quality and Strength of Evidence for Etiology: Example of Carpal Tunnel Syndrome
2008, Journal of Hand Surgery
The purpose of this investigation was to evaluate the quality and strength of scientific evidence supporting an etiologic relationship between a disease and a proposed risk factor using a scoring system based on the Bradford Hill criteria for causal association.
A quantitative score based on the Bradford Hill criteria (qBHs) was used to evaluate 117 articles presenting original data regarding the etiology of carpal tunnel syndrome: 33 (28%) that evaluated biological (structural or genetic) risk factors, 51 (44%) that evaluated occupational (environment or activity-related) risk factors, and 33 (28%) that evaluated both types of risk factors.
The quantitative Bradford Hill scores of 2 independent observers showed very good agreement, supporting the reliability of the instrument. The average qBHs was 12.2 points (moderate association) among biological risk factors compared with 5.2 points (poor association) for occupational risk factors. The highest average qBHs was observed for genetic factors (14.2), race (11.7), and anthropometric measures of the wrist (11.3 points) with all studies finding a moderate causal association. The highest average qBHs among occupational risk factors was observed for activities requiring repetitive hand use (6.5 points among the 30 of 45 articles that reported a causal association), substantial exposure to vibration (6.3 points; 14 of 20 articles), and type of occupation (5.6 points; 38 of 53 articles), with the findings being much less consistent.
According to a quantitative analysis of published scientific evidence, the etiology of carpal tunnel syndrome is largely structural, genetic, and biological, with environmental and occupational factors such as repetitive hand use playing a minor and more debatable role. Speculative causal theories should be analyzed through a rigorous approach prior to wide adoption.
Diagnostic III.
Risk factors for chronic venous disease: The San Diego Population Study
2007, Journal of Vascular Surgery
Citation Excerpt :
Connective tissue laxity, as manifested by previous hernia surgery or findings of flat feet, was a consistent risk factor for both moderate and severe disease. The association of increasing laxity in connective tissue with venous disease corroborated previous research.10-13 It is possible that previous hernia surgery may have been a marker for previous hospitalization and immobility; however, immobility was not significantly associated with venous disease in our data.
The etiology of chronic venous disease in the lower limbs is unclear, and very limited data are available on potential risk factors from representative population studies.
Participants in the San Diego Population Study, a free-living adult population randomly selected from age, sex, and ethnic strata, were systematically assessed for risk factors for venous disease. Categorization of normal, moderate, and severe disease was determined hierarchically through clinical examination and ultrasonography imaging by trained vascular technologists, who also performed anthropometric measures. An interviewer administered a questionnaire and an examination assessed potential risk factors for venous disease suggested by previous reports.
In multivariable models, moderate venous disease was independently related to age, a family history of venous disease, previous hernia surgery, and normotension in both sexes. In men, current walking, the absence of cardiovascular disease, and not moving after sitting were also predictive. Additional predictors in women were weight, number of births, oophorectomy, flat feet, and not sitting. For severe disease, age, family history of venous disease, waist circumference, and flat feet were predictive in both sexes. In men, occupation as a laborer, cigarette smoking, and normotension were also independently associated with severe venous disease. Additional significant and independent predictors in women were hours standing, history of leg injury, number of births, and cardiovascular disease, but African American ethnicity was protective. Multiple other postulated risk factors for venous disease were not significant in multivariable analysis in this population.
Although some risk factors for venous disease such as age, family history of venous disease, and findings suggestive of ligamentous laxity (hernia surgery, flat feet) are immutable, others can be modified, such as weight, physical activity, and cigarette smoking. Overall, these data provide modest support for the potential of behavioral risk-factor modification to prevent chronic venous disease.
Median Neuropathy
2005, Peripheral Neuropathy: 2-Volume Set with Expert Consult Basic

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^☆: This investigation was supported by PHS Grant 5T32 AM07230 awarded by the National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases and 5RO1 CA-21556 awarded by the National Cancer Institute, DHHS, and represents work carried out by the authors while at Yale University Department of Epidemiology and Public Health.

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General articleAn epidemiologic study of the carpal tunnel syndrome in an adult female population☆

Abstract

Lancet

Lancet

Carpal tunnel syndrome in ovariectomized women

Acta Obstet. Gynecol. Scand.

Incidence of hematologic disease in patients with carpal tunnel syndrome

JAMA

Statistical Methods in Cancer Research

Personal and occupational factors associated with carpal tunnel syndrome

J. Occupational Med.

The hand syndrome of pregnancy

Obstet. Gynecol.

Statistical Methods for Rates and Proportions

Carpal tunnel syndrome in pregnancy

South Med. J.

An epidemiologic study of epithelial carcinoma of the ovary

Amer. J. Epidemiol.

General article
An epidemiologic study of the carpal tunnel syndrome in an adult female population☆